Epilepsy treatment is medicinal and other means designed to relieve the symptoms of the disease and influence the cause in order to eliminate the acute manifestations of this pathology. For different types of epilepsy, different medications and their combinations are used. In 70% of cases, epilepsy can be effectively treated with medications that help control the course of the disease.
Concomitant therapeutic measures in the form of diet, daily routine, folk remedies can qualitatively complement the main therapy. Treatment begins with the establishment of a diagnosis based on diagnostic procedures by medical specialists. Self-medication for epilepsy can be dangerous not only for health, but also for the life of the patient and others, since seizures at work, for example, can lead to injuries to people.
Is a complete cure possible
With an acquired form of pathology, epilepsy can sometimes be cured completely. However, this disease has a peculiar character, patients may significantly change their behavior during seizures, which may partially complicate therapy.
In total, three types of epilepsy are known – hereditary, acquired (arising from traumatic brain injuries, inflammatory brain processes), causeless (when a causal relationship has not been identified). Benign epilepsy does not occur in adult patients, it is a childhood disease that passes with age even without medical intervention. However, some doctors consider epilepsy to be a chronic neurological disease with regularly recurring seizures and inevitable pathological consequences for brain structures.
In practice, there are often cases of the absence of progressive (progressive) course of epilepsy, when after a long absence of seizures, patients retain optimal thinking abilities. All this indicates the absence of an unambiguous answer to the question of a complete cure of epilepsy. Definitely, severe brain damage, epileptic childhood encephalopathy, meningoencephalitis are not cured.
Factors such as the nature of seizures in a particular patient, the age of the patient in which seizures manifested, the intellectual level of the person may affect how effective the therapy will be. At the same time, an unfavorable prognosis for treatment will be in such cases when:
- treatment begins untimely;
- therapy is ignored when the patient is at home;
- social circumstances that do not contribute to treatment;
- individual characteristics of the patient.
With epilepsy, a persistent focus of arousal occurs in the human brain. Nearby neurons in large groups begin to actively generate electrical potential, which then spreads to all other parts of the brain. To understand the function of antiepileptic drugs, it is important to know the mechanism of signal transmission from neuron to neuron. Electrical signals follow nerve fibers. The current in such fibers is formed by alternating opening and closing of ion channels on the cell surface. When calcium and sodium cations penetrate into nerve cells through special channels and counterflow of potassium cations, charge differences occur in the area of neural membranes, which is a nerve signal that will be transmitted subsequently along the nerve fiber. When an electric charge reaches nerve fibers, neurotransmitters are released from them using synaptic slits – special substances that will transmit signals to other neurons. Neurotransmitters excite cells (glutamate, for example) or reduce their activity (gamma-aminobutyric acid).
Antiepileptic drugs can affect all of the above stages, normalizing neural activity. All of them can be grouped with respect to the mechanism of influence on:
- Sodium channel blockers, among which Lamotrigine and Carbamazepine stand out. Lamotrigine blocks the release of glutamate and prevents the already circulating neurotransmitter from causing electrical signals in cells. Carbamazepine will block sodium channels on the surface of neurons, which will prevent signals from passing further.
- Agents that affect gamma-aminobutyric acid, which include Phenobarbital and Diazepam (tranquilizers), which cause high sensitivity of receptors to gamma-aminobutyric acid and thereby have a sedative effect.
- Calcium channel blockers, for example, Ethosuximide, which prevents the propagation of signals through nerve fibers.
- Modulators of synaptic vesicles of protein 2A – Levetiracetam, which enhances the effect of neurotransmitters that reduce the excitation of neurons. The remedy affects the brain in a complex way.
- Means of multiple exposure, which include Topiramate and Valproic acid. Topiramate increases the inhibitory properties of gamma-aminobutyric acid on the area of nerve cells. Valproic acid is used to increase the amount of gamma-aminobutyric acid in the central nervous system, but it can also presumably have a complex effect.
All medications can be divided into basic or traditional and new ones, which specialists received relatively recently. Traditional drugs have been studied more deeply, and new ones have a great potential for impact, but so far in the future. To date, new developments are used in addition to the main therapy with traditional means.
Antiepileptic drugs are one of the methods of therapy for epilepsy. Medications are available in tablets, capsules, granules for oral administration. Their effects can be immediate or delayed release. Immediate preparations very quickly provoke an increase in the concentration of active components in the blood and their rapid decline, which leads to increased exposure at the start of ingestion into the human body and a sharp decrease in exposure after reaching the peak of any drugs. Each subsequent decrease in the concentration of the drug provokes a weaker effect on the nervous system.
Delayed-release drugs have several layers of active substances that are placed on the base. When the tablet preparation is dissolved, all new portions of the substances necessary for treatment are gradually released. This leads to maintaining a constant concentration of the drug in the blood for a long time, reducing the frequency of taking medications. Such treatment is much more convenient for patients to use at home, which increases adherence to therapeutic prescriptions. Also, drugs with delayed release help to better control pathology, since when they are taken, there are no peaks in the concentration of the drug and its fall. With a similar effect, in addition to tablets, there are granules that are soluble in semi-liquid or liquid food, which can be used for children or in patients with difficulty swallowing.
Also, in addition to granules and tablets, drugs for the epilepsy treatment can be produced in the form of drops, syrups and solutions for injection. Such forms can be used for the therapy of pathology in childhood, as well as for the rapid relief of seizures or their series.
Common anticonvulsant medications in the treatment of epilepsy, in addition to those already mentioned, include:
These drugs help to stop seizures in various forms of epilepsy – temporal, focal, cryptogenic, idiopathic. Before using any drug, it is important to consider all possible complications from their use, since each drug can provoke severe side effects.
The greatest efforts in modern medicine are made for the treatment of epilepsy with relapses. In this case, patients are forced to take medications for many years, which causes addiction to medications. This state of affairs helps pathology to function despite treatment.
Correct treatment for epilepsy implies the correct dosage of medications that support the pathology in the right framework. Therapy can last for each patient a different amount of time. Its duration is directly affected by the frequency and duration of remission periods. With outpatient observation of the patient, it will be much easier for the doctor to prescribe the necessary dosage of funds.
When prescribing antiepileptic therapy, one drug is always used, since their combination can lead to the accumulation of toxic substances. The above-mentioned drugs are first-line medications when prescribed. These are the most studied drugs both regarding the therapeutic effect and the side effects produced.
There are also drugs of the second stage of appointment:
Such drugs are not very popular due to their lack of knowledge, or because of pronounced side effects. However, sometimes doctors choose them based on individual clinical pictures of patients and forms of seizures.
If drug therapy for epilepsy is ineffective, doctors sometimes use neurosurgical intervention, that is, they perform surgery on the patient’s brain. The development of seizures in epilepsy is always provoked by excessive activity of some part of the brain, called an epileptogenic focus. After the excitation of the epileptogenic focus, the activity can spread to other brain regions, and the patient begins an attack. The purpose of surgical intervention in this case will always be to limit the spread of excitation from the identified focus or its elimination together with a part of the patient’s brain.
The spread of such excitement can be limited by making incisions on the surface of the brain or dissecting the corpus callosum, which is an array of fibers that serve as a connecting structure between the cerebral hemispheres. Dissection of the corpus callosum will block the path of the transition of excitation from one hemisphere of the brain to another, which will help to avoid seizures in the future. Superficial incisions in the cortex block the path to other parts of the brain to arousal, and its partial removal helps to eliminate the source of the attack.
Before surgery, it is very important to accurately determine the localization of foci. Neurosurgery for epilepsy is used without reference to the age of patients, but it is not effective for every form of the disease or type of attack. Also, any operation may have irreversible complications with neurological disorders (for example, the patient may remain paralyzed).
In case of focal type of epilepsy, provoked by brain neoplasms or aneurysm, surgical treatment is indicated for the patient. Operations are most often performed without the use of general anesthesia to monitor the patient’s condition and prevent damage to the most important brain areas that are responsible for the functions of movement, thinking, and speech. Therefore, local anesthesia is used for surgical intervention on the brain in epilepsy.
Operations are also highly effective in the temporal form of the disease. The temporal lobe of the brain is either resected or the hippocampus with the amygdala is selectively removed. The second in this case is much better for the patient, and more than 90% of such operations end with the fact that a person never has seizures again.
With underdevelopment of the cerebral hemisphere or hemiplegia in children, such a hemisphere is completely removed by hemispherectomy. In primary idiopathic epilepsy, callosotomy is indicated, aimed at interrupting the connections between the cerebral hemispheres and, accordingly, getting rid of seizures.
When an epileptogenic focus is found in a certain area of the brain, neurosurgery can be used without moving. For pharmacoresistant epilepsy, this method is not suitable due to the multiplicity of constantly wandering lesions. In this case, doctors use the technique of neurostimulation of the vagus nerves.
Vagus nerves help the brain to control the work of the internal organs of the abdominal and thoracic cavity – the heart, lungs, stomach, part of the intestine. The nerve is paired, it descends from the left and right along the neck down from the brain. It is necessary to influence the vagus nerve on a permanent basis with the help of special equipment similar to a pacemaker. Electrodes for stimulation are attached to the nerve on the left and the pulse generator is placed subcutaneously. After implantation, the patient turns to the doctor to adjust the pulse frequency and monitor the condition of the device.
The method of vagus nerve stimulation has been used in the treatment of pharmacoresistant epilepsy for decades, but a clear mechanism of influence of such treatment is not yet fully clear. However, clinical data confirm the benefits of such a technique in children and adult patients whose epilepsy is resistant to drug treatment. Neurostimulation can also be used in combination with drug therapy if the latter is insufficiently effective or if surgical intervention is ineffective or impossible.
Laser therapy for epilepsy treatment
Sometimes magnetic laser therapy can be used to completely get rid of seizures. Laser therapy greatly facilitates the course of the disease in patients undergoing a full therapeutic course. The duration of laser therapy is usually about 1.5 years. It includes 3 main schemes of laser exposure, which are performed in a certain sequence and through set time intervals.
Laser therapy is performed using devices that can produce magnetic light waves. Using a laser allows you to:
- to increase the regenerative (adaptogenic) activity of the patient’s body, increasing the stability of impaired brain structures;
- reconstruct bioelectric brain activity;
- activate the process of RNA and DNA synthesis;
- normalize the brain rhythm;
- improve metabolic processes in the area of the cerebral cortex.
Laser therapy, which has been used for years, has demonstrated significant advantages from its use, compared with standard drug therapy. Among them:
- the compactness of the hardware unit for the technique, which is easy to move, which allows you to perform procedures at home, when moving patients in cars and so on;
- the use of laser therapy does not provide for the rejection of drug treatment, which can be gradually nullified after several laser courses have been completed;
- magnetic laser treatment allows you to minimize the dosage of drugs, and in mild forms of pathology – and completely eliminate them;
- the therapy has no allergic, side effects or toxic reactions of the body;
- the duration of treatment and the volume of medications used are significantly reduced.
On the eve of the appointment of laser therapy, patients with epilepsy must undergo tomography and electroencephalography. After the course of treatment, you will have to be examined again to assess the effectiveness of laser therapy in a particular case.
The second method of laser treatment of epileptics is thermal ablation. The procedure is performed under the control of magnetic resonance imaging, on the eve of the application of the method, an examination is carried out to identify the exact dislocation of foci.
The course of laser thermal ablation is a sequential drilling of a hole in the patient’s skull, where the laser beam is focused, creating high temperatures that turn off convulsive foci from the functionality of brain activity.
Laser thermal ablation contributes to the effective therapy of patients whose foci are located in inaccessible areas, as well as when mental changes occur during the course of the disease. The recovery period after laser thermal ablation is short, it is necessary to take medications for a short time after the intervention.
In modern medicine, new developments for laser therapy of epileptics are constantly being carried out, so there is a possibility that in the near future laser therapy will allow to completely eliminate seizures in patients.
Spa treatment for epilepsy does not bring any results, so this diagnosis cannot serve as an indication for a trip to a sanatorium. However, with concomitant pathologies and not severe forms of the underlying disease (if more than 3 months have passed since the last attack), you can go to a sanatorium if you exclude rehabilitation methods for treatment that can harm epilepsy.
For epileptics, physiotherapy (any electrical procedures), pharmacopuncture, acupuncture are contraindicated. Balneotherapy can be prescribed to patients individually. To a greater extent, spa treatment for patients with epilepsy is a way to relax, travel, which has a positive effect on the course of the disease and does not lead to the provocation of seizures.
How to stop an attack at home
What to do with an attack in a dream
Sometimes epileptic seizures are tied to sleep, occur either when falling asleep, or when waking up, or during a night’s sleep. This leads to a special helplessness of the patient, since at such a time he is usually alone in the room, which often leads to injuries, injuries from furniture corners or other dangerous household items. Therefore, in order to protect a person from possible night attacks, it is necessary to provide him with a sleeping place with a padded headboard to prevent bruises, always remove any sharp objects located next to the patient’s bed, provide the patient with a lower-height bed to minimize problems with a possible fall from it, and lay a soft thick carpet next to the bed for cushioning therefore, the bed should be equipped with only 1 pillow and, if possible, do not leave the patient alone at night.
An attack after alcohol
Some people are able to prevent alcoholic epilepsy attacks at home. This can be achieved if you subtly notice the harbingers of the disease. At the beginning of an alcoholic seizure, loss of consciousness and convulsions that have arisen, first aid should be given to the patient. First, the patient should be safely placed in a comfortable position where there are no hard or sharp objects nearby that can be hit or injured. The head is placed on a pillow, and the body itself is placed on its side to avoid ingestion of vomit into the respiratory tract or swallowing the tongue during an attack. If asphyxia (tongue sinking) has already happened, it is necessary to press on both sides of the lower jaw, open the mouth, get out and fix the tongue.
If the duration of seizures is more than a couple of minutes, it is urgently necessary to call an ambulance. If the seizures last more than 30 minutes, this indicates the occurrence of an epileptic status, which requires long-term complex therapy in a hospital setting.
Alcoholic epilepsy can be treated both in the hospital and at home, depending on the severity of the pathology. All therapy should be aimed at eliminating the cause, including medication, psychotherapeutic treatment and diet therapy. All this will prevent the occurrence of new seizures.
Relief of seizures in a child
For those who are present with an epileptic seizure, it is very important not to get lost and know how to stop it. This is especially important if the attack occurred in a child who is unable to independently deal with the precursors of the condition. The most important thing for those who are nearby is to be calm. It is required to lay the baby on its side, place a soft pillow under the head. It is not necessary to move the child constantly, you should immediately take care that there are no dangerous objects around the place where he lies. The baby’s head should always be on its side, in order to avoid asphyxia with the tongue or vomit. At the beginning of vomiting, it is worth turning the child’s head more to the side. It is absolutely impossible to unclench the baby’s teeth and stick objects into his mouth, just as it is impossible to water or feed the child. If the duration of a child attack is more than 5 minutes or constant repetitions of seizures, it is important to call an ambulance team in a timely manner. Medical intervention will also be required for the child in case of injury during the attack.
It’s not worth doing anything else with an attack. It will either pass by itself, or it will be stopped by qualified doctors. It is only important to ensure the safety of finding the baby during an attack and timely medical call.
Methods of treatment in children
Depending on what is the cause of childhood epilepsy, doctors prescribe different treatments. It is important not only to stop the attacks that occur in a timely manner, but also, if possible, to eliminate the cause of the disease. A huge number of modern anticonvulsants can help with all forms of epileptic seizures, it is only important to choose the right therapy in each case.
Usually anticonvulsive medications are prescribed to children with more than 2 seizures. Approximately 30% of all cases of drug therapy in children lead to a complete cure. If the form of pathology is severe, medications reduce the frequency and severity of seizures. Initially, the children’s dosage of all medications is very low. It is increased gradually to obtain a lightening effect. Then the therapy continues in the form that will completely eliminate the symptoms. However, it is important to remember that the treatment of epilepsy takes a long time, sometimes the child needs to be treated for months, and sometimes for years.
Consequences in the absence of treatment
When establishing the diagnosis of epilepsy, the patient’s therapy should be constant. In the absence of treatment, a variety of adverse consequences may occur in this case. For example, patients with seizures can get serious injuries, seizures that occur can create problems in society – at work, in the family. Also, without adequate treatment, seizures will become more frequent and more pronounced, which invariably leads to the formation of an epileptic status, very difficult to recover and life-threatening.
If patients first feel small seizures without convulsions, they may decide that they can just endure it. However, in the absence of treatment, they will soon turn into convulsive seizures, which will be more difficult to treat. Also, convulsive seizures can be evidence of severe brain pathologies. Untreated epilepsy significantly depresses the cognitive functions of the patient.
Release from recurrent seizures will lead to the restoration of normal life, reduce the risk of degradation of mental and intellectual abilities, therefore, it is extremely important to take medication for this disease.